The Specific Treatment for Problems of the Spine (STOPS) trial was completed in 2013 with the recruitment of 300 patients. It is the first randomised controlled trial showing moderate to large effects favouring the specific physiotherapy. The treatment evaluated was the same used by the Advance Healthcare team that is used with patients on a daily basis. Our research team in association with La Trobe University is currently working to publish this paper in a high quality journal. You can see some of the results in the graph below. It shows that specific physiotherapy is 50% more likely to result in a 50% improvement in daily activity capability compared to standard and guideline-based treatment. The evidence is clear; the treatment program developed and used by Advance Healthcare works!

WHAT ABOUT THE DIAGNOSIS?

Current guidelines advise that diagnosing back pain is not possible (Koes et al 2010). Some even suggest that thinking about the injured structure when treating back pain may cause more harm than good (Dagenais et al 2010). However there is now reasonable evidence, that using clinical methods developed by the Advance Healthcare team that injuries such as disc related pain can be identified and treated (Ford et al 2013). Part of this evidence is provided by an outstanding paper from Michael Adams that recommends practitioners think about the disc in the lumbar spine and how different treatments can actually increase the rate of healing. Some still doubt that healing in the disc is relevant to treating back pain. But look at the picture above; it is a cross section of an injured disc where a blood vessel has grown and is laying down scar tissue. A variety of physiotherapy methods can accelerate this healing process. These methods have been proven as successful in the STOPS trial.

SOMETHING FOR PRACTITIONERS

There were 5 different treatment types in the STOPS trials. As we want to help as many people with back pain as possible, its important that these complex treatments were published for practitioners to access. Our papers (approximately 10,000 words each) have all been published in Physical Therapy Reviews and are available on our practitioner education website KALSI.com.au.

This flow chart is an example of some of the decision making rules used in the STOPS trial to help practitioners negotiate difficult treatment scenarios. The example outlines clinical reasoning strategies when a person presents with back pain that has recently worsened.

MORE ON DIAGNOSIS

This is another paper we have published on how to diagnose back pain; this time using an expert panel to establish diagnostic features. The paper, written by one of my PhD students Viktoria Wilde and Jon Ford, showed which features were more likely to be diagnostic of the zygaphophyseal (or facet) joint as the cause of a person's back pain. The results of this study converge with a range of other evidence to support the diagnostic features we use clinically and in the STOPS trial.

TREATING BACK PAIN IS COMPLEX

This figure is from a paper Jon Ford published on the complexity of treating back pain. In it, we urged practitioners of all disciplines to act professionally by using a progressive "building block" approach to acquiring evidence-based knowledge. We wrote this out of concern for some practitioners picking up on the latest "trends" in back pain research, rather than integrating new evidence with established current clinical practice. The aim of our approach to back pain is to provide practitioners with a clear and structured approach to dealing with complex clinical problems.

4. Individualised-physiotherapy as an adjunct to guideline-based advice for low-back-disorders in primary care: a randomised controlled trial. British Journal of Sports Medicine. In press. (Impact Factor 5.025 – December 2014)

22. Stanhope, M, Ford JJ. Practical implementation of treatment guidelines in a workers’ compensation environment: A new approach. The Journal of the International Association of Industrial Accidents Boards and Commissions 2008;45:207-223.

25. Ford JJ, Story I, O’Sullivan P, McMeeken JM. Classification systems for low back pain: A review of the methodology for development and validation. Physical Therapy Reviews 2007;12:33-42.

26. Stanhope M, Ford JJ. The critical role of evidence-based decision support systems to deliver the intended benefits of treatment guidelines in workers’ compensation. The Journal of the International Association of Industrial Accidents Boards and Commissions 2006; Autumn:35-60.

27. Ford JJ. Pathological and psychosocial considerations in massage of the lumbar spine. Journal of the Australian Association Massage Therapists 2007;Spring:14-18.